“Think about it: It is just like H&R Block “maximizing your tax refund”… except you and your family are headed to Disney courtesy of the local not for profit facility” – Doug Aldeen
RE: Thousands of WA patients getting refunds in PeaceHealth billing case
Takeaways and potential strategies moving forward by Doug Aldeen:
1. Member/patient financial information (household income/tax returns) is equally as important as both medical and Rx claims data and should be required as a condition of enrollment coupled with an authorization to submit the applicable paperwork to the facility;
2. Retrospective charity scrubs should not be limited to the government enforcing a not for profit facility’s charitable obligation. EVERY plan sponsor should do this annually as well. More to the point, the MOST a facility can charge a partial qualifier is its AGB percentage. If facility billing is fundamentally FUBAR and rife with errors, I can almost assure you that checking the math is critical for a partial qualifier. Remember, 80% of the US qualifies either in whole or in part for financial assistance at 400% of the FPL. There are member dollars on the table and downstream plan savings if the benefit was excluded from coverage. Think about it: It is just like H&R Block “maximizing your tax refund”… except you and your family are headed to Disney courtesy of the local not for profit facility… .
3. Contingent upon plan design, any raise to an employee that moves them out of eligibility for financial assistance should be carefully considered.
